Report shows repeated problems in Mental Health Care

Care Quality Commission report warns that Mental Health Social Workers are under severe pressure as councils cut there numbers.

In spite of rising work loads and increased demand for support, the report shows that councils are actually reducing the amount of Approved Mental Health Practicioners (AMHP) they employ and further increasing the work of already struggling social workers.

Some overall improvement but most of the concerns highlighted in previous reports remain, particularly in respect of care planning, patient involvement and consent to treatment.

37% of care plans checked by CQC showed no evidence of patients' views.

There was no evidence that patients had been informed of their legal right to an Independent Mental Health Advocate (IMHA) in 21% of records reviewed.

Almost half (45%) of patient records reviewed still showed no evidence of consent to treatment discussions before the first administration of medication to a detained patient

There is a significant gap between the realities CQC is observing in practice and the ambitions of the national mental health policy - No Health without Mental Health.

CQC is concerned that cultures may persist where control and containment are prioritised over the treatment and support of individuals. In this kind of culture, ‘blanket rules' can become institutionalised.

On one in five visits, CQC expressed concern about the de facto detention of patients who were voluntary rather than compulsory patients.

The report found that patients detained under the Mental Health Act on March 31st 2012 has risen by 5% from the previous year, and people subject to community treatment orders (CTOs) has risen 10% from 2010/11.

They have also been given more statutory duties to do in the last five years, such as responsibilities for agreeing to and renewing CTOs on their introduction in 2008 and they may also be trained as best interest assessors under the Deprivation of Liberty Safeguards.

Even though these numbers have increased in the last year adding to the rising workloads with additional duties, the report showed that some local authorities had actually cut AMHP numbers.

The CQC also found that some hospitals were failing to involve patients in decisions about their treatment. The Department of Health says the report confirms "institution bias" after the regulator visited 1,546 wards and examined people who were detained under the act, and the treatment of people given community care subject to the act.

The report says during one hospital visit none of the patients interviewed felt involved in plans about their care or treatment, and were unaware of what they needed to do for their discharge to be considered.

The report shows that some hospitals and wards are doing a very good job in treating patients with dignity and respect, but CQC says:

It has proved all to easy for cultures to develop in which blanket rules deny people their basic rights - especially the right to dignity.

They also found a continued shortage of mental health beds which puts "services and patients under stress", the CQC found. In 93 wards (6% of all wards) visited, they had more patients than beds; in one service 27 patients were allocated to 19 beds.

This has lead to some AMHPs feeling asthough they are forced to detain patients under the Mental Health Act as a means of getting access to a bed, with certain hospitals having an "aversion" to voluntarily admitted patients, and in spite of there being good progress in AMPHs finding other possibilities instead of hospital admission, it was often a case of a lack of alternative options.

Steve Chamberlain, chair of The College of Social Work's AMHP leads network, said:

This chimes closely with the national AMHP survey last year in which stress was widely reported. It found that statutory work was becoming increasingly squeezed with little or no accommodation for the demands of care coordination.

Trusts and local authorities must address this issue if AMHPs are to continue to work effectively and safely.

Joe Godden, professional officer, the British Association of Social Workers (BASW), said:

Ministers, care trusts and social service departments need to take the report seriously. It is totally unacceptable that the same issues recur as in previous similar reports, with certain practices actually getting worse.

Patients in a number of units are benefiting from good care planning, but it is concerning that more than a third of care plans showed no evidence of discharge planning. This is at the heart of social work and social care.

The reasons for this are not fully explored in the report. Undoubtedly pressure on beds is a factor. BASW members report their frustration that referrals for discharge planning are not always made to social workers, or community mental health teams. We would like further exploration and analysis of this problem.

Being involuntarily detained under the Mental Health Act is one of the most serious things that can happen to someone in terms of their mental health.

For this reason it should only happen if it is absolutely necessary, with great care and in strict adherence with the procedures laid out in the Act.

Today's report shows that, in many cases, people's basic human rights are being infringed at a time when they are likely to be at their most vulnerable.

The overall rise in detentions and community treatment orders is very worrying and is symptomatic of problems elsewhere in mental health services. It is a wake-up call for the Department of Health and a clear signal to the NHS commissioning board and clinical commissioning groups that, as they begin to assume responsibility for health services, mental health must be a top priority.

It's frustrating to see that the findings provided by the report remain pretty much the same year after year in showing large over-representation of certain black and minority ethnic groups.

A lot of work has been done to identify the specific problems that need to be addressed, but neither government, nor providers, seem willing to make the long term commitment to working with local communities that will be required to deliver change.

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